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N51 <br />NOTICE OF RESTRIC'.TION OF USE <br />and Notice of Right to Appeal 61 D <br />DATE: D C] '�' TIME: CASE #:! <br />LOCATION (.PARK/OPEN SPACE):A.51i7 kv -,— � 5v ^j �ikle /0)z— <br />r- <br />0)z- <br />r- <br />Naine. ast j� First ! , Ntid Ile <br />AVA55 55 1 f' } a <br />DOB:IF <br />R tceiSt <br />Res A Id'Cit <br />State <br />7 <br />S§. one: <br />Work Phone <br />—+-- <br />Ci <br />a <br />J,i <br />Linder the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1.005(3), you are hereby <br />notified that you are prohibited from (check box): <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />The basis for this Notice of Restriction of Use is that on �l 1r-�1 S you violated Section /dlo— of the Park <br />and Open Space. Rt}les, and/or Section / of the Eugene Code, 1971, and/or DRS . To wit, you: <br />(Description of the violation.) j <br />This restriction of use is effective beginning on '� , and shall remain in effect until <br />If you enter in or use any City of Eugene park, open space or facility during the effective period of this Notice, you may be <br />arrested and charged with criminal trespass in the second degree. <br />Pursuant to Park and Open Space Rule R-1.074 you are entitled to an informal hearing to contest this Notice. A request For an <br />informal hearing must be made in writing and filed with the Parks & Open Space Division Director ("the Division Director") <br />within 48 hours (.exclusive ofweekends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedule a time and place for the informal hearing to be conducted, which shall be not more than <br />72 hours (exclusive of weekends) of receipt of the request for hearing. At the: infornial hearing the Division Director will only <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, and other witnesses to the <br />incident. The Division Director may exclude anyone, other than you and those presenting testimony, From the informal hearing. <br />This Notice shall remain in effect pending any requested. hearing, <br />This Notice of Exclusion was delivered to the person named at the top of this Notice qjJL4-4nte-&nfd ime, shown above by: <br />1!nature ofper' n issuing./delivering notice) <br />1 hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signature of person being issued the notice) <br />White Cory: Public Works Green Copy: file Yellow Copy: Report Copy Pink Copy: Recipient GuldCopy: Officer Appeal notiec Kev 04�0 <br />